Achieving superior resurfacing results with the erbium:YAG laser.

Laser skin resurfacing has become increasingly popular. The carbon dioxide (CO2) laser seemingly remains the most commonly used laser modality for skin resurfacing. Many surgeons still promote the CO2 laser as being superior to the erbium:YAG laser, particularly for individuals with deeper lines. However, further experience with the erbium:YAG laser has shown the converse to be true. The erbium:YAG laser can be used to treat deep rhytids successfully, many times achieving results superior to those seen with the CO2 laser, particularly in the perioral region. The theory behind this relates to the 10-fold greater absorption of the erbium:YAG wavelength by water. The greater absorption produces more efficient vaporization, even at low fluences, with greatly reduced adjacent thermal injury. Ablation can be carried to deeper levels of the dermis than is consistently safe with the CO2 laser. Deliverance of total fluences in the range of 100 to 150 J/cm2, or more, produces a marked reduction or elimination of deeper rhytids. Clinically, experience with more than 300 cases indicates collagen remodeling occurs to a similar degree with the erbium:YAG laser as with the CO2 laser, as improvement in rhytids can be seen for 2 to 3 months after surgery. It would appear that superior results can be obtained without the "heat effect" of the CO2 laser. The erbium:YAG laser is capable of achieving superior resurfacing results, while offering many advantages to the patient, eg, reduced anesthetic requirements, shorter healing time, reduced erythema, less risk of pigmentary change, and more flexibility for resurfacing the skin off of the face.